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Epidural Kateter Uygulanan Total Abdominal Histerektomi Operasyonu Geçiren Hastalarda Deksmedetomidinin Postoperatif Analjezik Kullanımına Etkileri

Year 2019, Volume: 26 Issue: 2, 165 - 173, 01.06.2019
https://doi.org/10.17343/sdutfd.383697

Abstract

AMAÇ

Çalışmanın amacı,
total abdominal histerektomi geçiren hastalarda, epidural kataterden verilen
deksmedetomidinin postoperatif aneljezik kullanımına etkilerini araştırmak.

GEREÇ-YÖNTEM

Çalışmaya ASA
I-II, 30-60 yaş arası, operasyon süresi 150 dakikayı geçmeyen genel anestezi
uygulanmış hastalar alındı. Çalışma kriterlerini sağlayan ve postoperatif
aneljezi sağlamak için preoperatif epidural katater takılmış hastaların
verileri değerlendirildi.

Dosya kayıtları
incelenen hastalar iki gruba ayrıldı. Bupivakain (Grup B) 5 ml% 0.5 bupivakain
+ 11 ml% 0.9 sodyum klorür) veya  bupivakain
+ deksmedetomidin (Grup D) 5 ml% 0.5 bupivakain + 1 ml deksmedetomidin (0.5 μg
/ kg) +10 ml% 0.9 sodyum klorür  ameliyat
sonrası analjeziyi sağlamak için cerrahi yara kapanması sırasında epidural kateter
yolu ile bolus olarak verilmiş. Her iki gruptaki hastalara postoperatif 24 saat
boyunca epidural analjezi için PCA cihazı ile morfin + bupivakain uygulanmış.

Anestezi takip
fişlerinden; demografik ve hemodinamik veriler, algoloji takip formlarından;
analjezik talep sayıları, analjezik tüketimleri, VAS skorları, Ramsay sedasyon
değerleri ve yan etkiler kaydedildi.

BULGULAR

Demografik
veriler, hemodinamik parametreler, VAS skorları, Ramsay sedasyon değerleri ve
yan etkiler açısından gruplar arasında fark bulunmadı. Postoperatif
30.dakikadan itibaren Grup D de, Grup B ye göre daha az analjezik talebi, daha
az bupivakain ve morfin tüketimi olduğu görüldü ve istatiksel olarak anlamlı
bulundu. (p<0.05)

SONUÇ



















Postoperatif
analjezi sağlamak amacıyla epidural bupivakaine eklenen 0,5 µg/kg
deksmedetomidin; postoperatif 30. dakikadan itibaren analjezik talep sayısıyla
birlikte morfin ve bupivakain tüketiminini azalttığı kanısındayız.

References

  • 1. Beyaz SG, Bayar F, Erdem AF. Acute postoperative pain. J Anesthe Clinic Res 2011; S7:002. 2. Jin F, Chung F. Multimodal Analgesia for postoperative pain control. Journal of Clinical Anesthesia 2001; 13: 524-39. 3. Kehlet H, Dahl JB. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg 1993; 77: 1048-56. 4. Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg 2008; 107: 2056-60.
  • 5. Karhade SS, Acharya SA, Harnagale K. Comparative analysis of epidural bupivacaine versus bupivacaine with dexmedetomidine for vaginal hysterectomy. Anesth Essays Res. 2015; 9(3): 310. 6. Yousef AA, Salem HA, Moustafa MZ. Effect of minidose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural anesthesia: a randomized double-blinded controlled study. J Anesth. 2015; 29(5): 708. 7. De Beer JV, Winemaker MJ, Donnelly GA et al. Efficacy and safety of controlled-release oxycodone and standard therapies for postoperative pain after knee or hip replacement, Can J Surg, 2005; 48(4): 277-83.
  • 8. Jain D, Khan RM, Kumar D, Kumar N. Perioperative effect of epidural dexmedetomidine with intrathecal bupivacaine on haemodynamic parameters and quality of analgesia. South Afr J Anaesth Analg. 2012; 18: 105–9.
  • 9. Safiya I Shaikh, Sarala B Mahesh The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries J Anaesthesiol Clin Pharmacol 2017; 32: 203-9.
  • 10. Pratibha JS, Rashmi N, Chandrapal B, Kunal T. Dexmedetomidine V/S Fentanyl with 0.75% Ropivacaine for Epidural Anaesthesia in Lower Abdominal Surgeries - A Comparative Study J Anest & Inten Care Med. 2017; 3(3): 555611.
  • 11. Bajwa SC, Bajwa KS, Kaur J, Singh G. Dexmedetomidine and clonidine epidural anaesthesia: Acomparative evaluation. Indian Journal of Anaesthesia 2011; (55): 116-121. 12. Agarwal S, Singh RB, Singh D, Kumar M. Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation International Journal of research in medical sciences 2015; 3(11): 3254-61.
  • 13. Gupta K, Rastogi B, Gupta PK, Jain M, Gupta S, Mangla D. Epidural 0.5% levobupivacaine with dexmedetomidine versus fentanyl for vaginal hysterectomy: A prospective study. Indian J Pain 2014; 28: 149-54.
  • 14. Hanoura SE, Hassanin R, Singh R. Intraoperative condition and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia. Anesthesia 2013; 7: 16.
  • 15. Ohtani N, Yasui Y, Watanabe D et al. Perioperative infusion of dexmedetomidine at a high dose reduces postoperative analgesic requirements: a randomized control trial, Journal of anesthesia, 2011; 25(6): 872-878.
  • 16. Nupoor N, Talikoti A, Kumar PB, Dinesh K, Epidural bupivacaine with dexmedetomidine or fentanyl for lower abdominal and lower limb surgeries - a randomized prospective study J Clin Biomed Sci 2016; 6(1): 14-19 .
Year 2019, Volume: 26 Issue: 2, 165 - 173, 01.06.2019
https://doi.org/10.17343/sdutfd.383697

Abstract

References

  • 1. Beyaz SG, Bayar F, Erdem AF. Acute postoperative pain. J Anesthe Clinic Res 2011; S7:002. 2. Jin F, Chung F. Multimodal Analgesia for postoperative pain control. Journal of Clinical Anesthesia 2001; 13: 524-39. 3. Kehlet H, Dahl JB. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg 1993; 77: 1048-56. 4. Carney J, McDonnell JG, Ochana A, Bhinder R, Laffey JG. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy. Anesth Analg 2008; 107: 2056-60.
  • 5. Karhade SS, Acharya SA, Harnagale K. Comparative analysis of epidural bupivacaine versus bupivacaine with dexmedetomidine for vaginal hysterectomy. Anesth Essays Res. 2015; 9(3): 310. 6. Yousef AA, Salem HA, Moustafa MZ. Effect of minidose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural anesthesia: a randomized double-blinded controlled study. J Anesth. 2015; 29(5): 708. 7. De Beer JV, Winemaker MJ, Donnelly GA et al. Efficacy and safety of controlled-release oxycodone and standard therapies for postoperative pain after knee or hip replacement, Can J Surg, 2005; 48(4): 277-83.
  • 8. Jain D, Khan RM, Kumar D, Kumar N. Perioperative effect of epidural dexmedetomidine with intrathecal bupivacaine on haemodynamic parameters and quality of analgesia. South Afr J Anaesth Analg. 2012; 18: 105–9.
  • 9. Safiya I Shaikh, Sarala B Mahesh The efficacy and safety of epidural dexmedetomidine and clonidine with bupivacaine in patients undergoing lower limb orthopedic surgeries J Anaesthesiol Clin Pharmacol 2017; 32: 203-9.
  • 10. Pratibha JS, Rashmi N, Chandrapal B, Kunal T. Dexmedetomidine V/S Fentanyl with 0.75% Ropivacaine for Epidural Anaesthesia in Lower Abdominal Surgeries - A Comparative Study J Anest & Inten Care Med. 2017; 3(3): 555611.
  • 11. Bajwa SC, Bajwa KS, Kaur J, Singh G. Dexmedetomidine and clonidine epidural anaesthesia: Acomparative evaluation. Indian Journal of Anaesthesia 2011; (55): 116-121. 12. Agarwal S, Singh RB, Singh D, Kumar M. Epidural bupivacaine combined with dexmedetomidine or clonidine in infraumbilical surgeries: a comparative evaluation International Journal of research in medical sciences 2015; 3(11): 3254-61.
  • 13. Gupta K, Rastogi B, Gupta PK, Jain M, Gupta S, Mangla D. Epidural 0.5% levobupivacaine with dexmedetomidine versus fentanyl for vaginal hysterectomy: A prospective study. Indian J Pain 2014; 28: 149-54.
  • 14. Hanoura SE, Hassanin R, Singh R. Intraoperative condition and quality of postoperative analgesia after adding dexmedetomidine to epidural bupivacaine and fentanyl in elective cesarean section using combined spinal-epidural anesthesia. Anesthesia 2013; 7: 16.
  • 15. Ohtani N, Yasui Y, Watanabe D et al. Perioperative infusion of dexmedetomidine at a high dose reduces postoperative analgesic requirements: a randomized control trial, Journal of anesthesia, 2011; 25(6): 872-878.
  • 16. Nupoor N, Talikoti A, Kumar PB, Dinesh K, Epidural bupivacaine with dexmedetomidine or fentanyl for lower abdominal and lower limb surgeries - a randomized prospective study J Clin Biomed Sci 2016; 6(1): 14-19 .
There are 10 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Articles
Authors

Ali Koçman This is me

Ümit Fiğançiçek This is me

Filiz Alkaya Solmaz 0000-0001-5772-6708

Pakize Kırdemir This is me 0000-0001-7784-1818

Publication Date June 1, 2019
Submission Date January 25, 2018
Acceptance Date February 10, 2018
Published in Issue Year 2019 Volume: 26 Issue: 2

Cite

Vancouver Koçman A, Fiğançiçek Ü, Alkaya Solmaz F, Kırdemir P. Epidural Kateter Uygulanan Total Abdominal Histerektomi Operasyonu Geçiren Hastalarda Deksmedetomidinin Postoperatif Analjezik Kullanımına Etkileri. Med J SDU. 2019;26(2):165-73.

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